Mental illness is no excuse for turning a blind eye to smoking

Mentally ill Australians have a life expectancy 25 years lower than the rest of the population. AAP

Almost half of all cigarettes smoked in Australia, the US and the UK are smoked by people with a mental illness. It’s a startling statistic and it paints a grim picture for the physical health of the one in five Australians that experience mental illness.

Much of the burden of mental illness is compounded by the social and physical impacts of smoking.

People with severe mental illness die, on average, 25 years sooner than they should. They’re also two to three times more likely to become chronically ill than people without mental health problems.

Risk of chronic disease

Cardiovascular disease, in particular, is a leading cause of death in smokers with mental illness.

Diabetes is the third-leading cause of death for people with schizophrenia, after suicide and epilepsy. Diabetes has become so insidious in this group that schizophrenia is likely to be officially recognised as an independent risk factor for diabetes.

People with schizophrenia also have a ten-fold increased death rate from respiratory disease and cigarettes are the main culprit.

Mortality rates for cancer are significantly higher for these populations too, most likely due to insufficient early detection, treatment and care. It’s a case of too little, too late.

What makes these statistics even more concerning is many people with mental illness have more than one of these health problems.

Clearly, the human costs of smoking are substantial, not only for the individual, but for their family and the community as well.

Starting the habit

Like all smokers, people with mental illness begin smoking for many reasons. Chicken and egg debates about what came first haven’t got us very far.

It’s more important to recognise that psychiatric symptoms, stress, coping, and nicotine addiction and withdrawal are enmeshed processes. Cigarettes can serve many purposes in the absence of other strategies for coping with mental illness and life’s ups and downs.

Until quite recently, psychiatric hospitals did virtually nothing to curb patients’ smoking. In the absence of meaningful support, cigarettes have been the currency through which many staff interact with patients, and patients interact with each other.

This institutional mindset has filtered through to community care. Across mental health and physical health care settings, we have largely ignored the physical health problems of those with mental illness.

This statement, made by an influential psychiatrist about patients with schizophrenia, gives some sense of the problem: “Poor devils, they haven’t got much left,” he said, “If they want to smoke, let them.”

The other argument is that smoking is “their only pleasure”. But how the hell did things get this bad that smoking is perceived as their only pleasure?

Solutions

If we’re to address this problem, we first need to believe that solutions are worthwhile, and possible.

We know that mentally ill smokers are just as concerned about their smoking as anyone else. Many want to quit but feel they can’t succeed or are frightened of becoming unwell if they try to break the habit.

First, health and social welfare providers need to understand that people with mental illness have complex life histories that impact on their health behaviour, and affect their ability to access services.

A multi-layered and systematic response is needed, across sectors such as health, welfare, housing, community and media.

Health and welfare workers need support, training and practical tools to encourage those with a mental illness to quit.

Importantly, these health and welfare workers need to break down the boundary between “us” and “them” which has perpetuated a sense of hopelessness in the very people they’re caring for.